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Navy & Marine Corps Medical News
March 24, 2000
The Navy Bureau of medicine and Surgery distributes Navy
and Marine Corps Medical News (MEDNEWS) to Sailors and
Marines, their families, civilian employees and retired
Navy and Marine Corps families . To achieve maximum medical
information distribution, your command is highly encouraged
to distribute MEDNEWS to ALL HANDS electronically, include
MEDNEWS in command newspapers, newsletters and radio and TV
Stories in MEDNEWS use these abbreviations after a Navy
medical professional' s name to show affiliation : MC -
Medical Corps (physician) ; DC - Dental Corps; NC - Nurse
Corps; MSC - Medical Service Corps (clinicians, researchers
and administrative managers) . Hospital Corpsmen (HM) and
Dental Technician (DT) designators are placed in front of
Contents for this week's MEDNEWS:
Headline: Hearing loss a readiness issue (photos)
Headline: New approaches to preventing hearing loss
Headline: Carrier' s first physical therapist is no pain in the neck
Headline: Research seeks answer to spatial disorientation problems
Headline: Exceptional Family Member Program gets new instructions
Headline: Great Lakes blood bank accredited
Headline: Anthrax question and answer
Headline: TRICASE question and answer
Headline: Healthwatch: Oral cancer: are you at risk?
Headline: Hearing loss a readiness issue (photo)
By Capt . Jane F. Vieira, CHC, Naval Sea Systems Command
CRYSTAL CITY, Va. — Hearing as a readiness issue, with
focus on noise-induced hearing problems were the topics of
the Navy's first syn^osium on hearing loss held Feb. 4th at
Naval Sea Systems Command.
More than 20 military and civilian experts in research
audiology and acoustics engineering from across the country
met to address and seek solutions to the impact of noise on
operational readiness aboard surface ships.
The conference looked at the effect of noise on
performance and safety as well as how the problem concerns
the entire spectrum of naval personnel.
Subject matter experts presented studies demonstrating
that many Sailors leave the Navy with significant hearing
loss and that 282, 000 service members currently collect
compensation for hearing damage.
Vice Adm. Pete Nanos, commander. Naval Sea Systems
Command said noise impacts the readiness of the Navy in
many ways: poor or lost communications, sleep deprivation,
fatigue, reduced alertness, safety, retention, morale,
habitability, as well as short and long term hearing loss.
Nanos said hearing conservation is an issue of
readiness, safety, health and quality of life. Fixing this
problem is an ethical and leadership issue, and it is the
right thing to do.
Hearing stress, which is measured in decibels, increases
on a logarithmic scale. Symposium experts demonstrated how
the majority of sounds encountered by military personnel
potentially fall within a dangerous range of sound pressure
Continuous background noise, as experienced on most
surface ships, begins hearing stress. Additional noise
peaks, such as firing weapons or aircraft launches,
superimposed on continuous background noise can cause even
greater damage. Hearing research has also concluded that
humans adapt to higher noise levels, and consequently
become accustomed to harmful sound levels.
While hearing has been viewed as more of a health or
quality of life issue, existing data increasingly suggest
it is also a significant operational readiness concern.
Aboard aircraft carriers, the steady and intermittent
noises created by launching and recovering aircraft 24-
hours—a—day produce deafening noises from jet engines at
full power, arresting gear machinery, arresting cable slap,
catapult launches, waterbrakes and more.
Better hearing protection devices, currently being
deployed, was one of the solutions to the problem of noise
on surface ships presented at the conference. Discussions
also included the use of pharmacological methods to prevent
and reverse hearing loss.
These methods are in pre— clinical trials and appear to
offer exciting and cost-effective strategies to reduce
permanent hearing loss from excessive noise. Acoustic
technology is also providing solutions, especially in the
commercial arena .
Quiet fans and motors, new insulation materials,
laminated sheet metal, better joiner systems, and effective
communication earpieces are all being used commercially in
active noise control efforts.
Nanos challenged those at the symposium to raise the
priority of hearing loss prevention with completed studies
and data assimilation.
"NAVSEA' s goal for the 21st century is not only to
eliminate the impact of noise as a factor in operational
readiness and to increase shipboard quality of life, but to
do our part in keeping Sailors and Marines out of hearing
conservation programs rather than just preventing hearing
loss, " he said.
Headline : New approaches to preventing hearing loss
By Col. Richard Kopke, MC, USA, Naval Medical Center San
SAN DIEGO — Traditional approaches to prevent hearing
loss in military settings have included efforts to engineer
weapons systems and work spaces to be quieter, personal
protection devices, and hearing conservation programs.
Considerable reduction in noise— induced hearing loss has
occurred since WW II.
Still, there are physical and human factors which reduce
the effectiveness of personal hearing protection devices
such as transmission of sound energy through the skull
directly to the inner ear, the need for a perfect seal of
the protective device, discomfort, and the element of
These are some of the compelling reasons why a
pharmacological approach to preventing or reversing noise-
induced hearing loss may be attractive . This approach
involves making the inner ear more resistant to noise
through the use of antioxidant compounds, or in some cases
reversing hearing loss using rescue agents.
Most military personnel are exposed to damaging levels
of noise during defined periods of training such as weapons
training, flight operations, live fire exercises or duty in
engine rooms. The antioxidant compounds could be given to
personnel around the time of such exposures along with
mechanical protectors. The combination would more
effectively reduce permanent hearing loss.
Another approach would be to closely monitor hearing
levels and administer rescue agents to those personnel who
develop hearing loss over these defined periods of intense
noise exposure. This would enhance the ear's ability to
recover and rest prior to further noise exposures.
Headline: Carrier' s first physical therapist is no pain in
the neck (photo)
By JOl (AW) John Joyce
USS GEORGE WASHINGTON (CVN 73) — "As a newly hired
physical therapist at a civilian hospital or clinic, I
would step into a wonderful office and inherit a pre-
established physical therapy program," said Lt. Janice
Rinkel, USS George Washington' s (CVN 73) first physical
therapist . "That would be comfortable. But I'm still kind
of an adventurous person and that's why I'm here."
"The adventure of coming aboard a great warship and the
chance to say, ^hey, I get to set up this clinic, ' is a
great challenge but it's a challenge I feel I'm up to,"
She checked aboard the "Spirit of Freedom" in November
of 1999 as part of a Bureau of Medicine and Surgery five-
year trial, which incorporates physical therapy into
medical programs aboard aircraft carriers.
"J wasn't surprised when my detailer gave me two days to
decide which of two carriers I would choose, " Rinkel said.
"X knew the new initiative to put a physical therapist on
each carrier was coming. I knew of GW s great reputation
and looked at it as an opportunity to experience life at
sea, something my medical colleagues in Portsmouth have not
been able to do."
Rinkel' s new billet is also an opportunity for GW
Sailors to receive needed physical therapy within one to
two days conveniently aboard ship rather than dealing with
traffic, and an average of two to three weeks waiting for
an appointment at a local hospital or clinic.
"J don't think a lot of people know that I'm on the ship
yet," said Rinkel. "When patients are referred to me by a
physician' s assistant or general medical officer, they are
amazed and say, 'J can actually come here for treatment
aboard ship rather than battle traffic to a clinic!"
Rinkel' s mission aboard extends beyond reducing lost
"If I can do some simple adjustments on a Sailor' s back
and get him or her off light duty within one or two days
versus two weeks, it will do more than save man-hours, " she
said. "It will eliminate pain. You can see the relief on
their faces. They are not dealing with the pain or taking
Motrin any longer. The fact that Sailors are happier and
healthier makes a big difference to job performance and the
overall mission of the ship. "
Keeping GW Sailors happier and healthier without
protracted follow— up visits is another goal that Rinkel
hopes to achieve, and she plans to do it by applying a
common medical principle — prevention. She's been
practicing the principle since running track in high
"What really struck me when I ran track in high school
was that sports medicine dealt with the whole body, " said
Rinkel . "Aboard GW, we will also prevent injuries in that
way with stretching exercises, muscle re-education and
strengthening . If a Sailor needs physical conditioning, we
have gyms aboard ship with machines and free weights that
will do that as well . A technician will soon be coming
aboard to assist with treatment and the strength and
conditioning programs . "
Preventive medicine classes and a preventive medicine
folder on the LAN are two ways Rinkel proposes to increase
awareness about preventing injury aboard ship.
"After only two-and-a-half months aboard GW, I've
already seen some things that can be changed for the
better," said Rinkel. "I've seen what people go through on
the ship and what the typical injuries are. We can prevent
a lot of chronic neck and back pain if Sailors would modify
what they do. We'll take a look at workstations, exercise
equipment, and running shoes. I'll post information on the
LAN that anybody can pull up explaining how to order the
correct shoes. That alone will decrease a lot of knee
pain. We'll show people what to do if their back hurts and
educate them on the correct way to work out. In effect,
we'll give people the tools and know— how to treat
themselves . "
Headline: Research seeks answer to spatial disorientation
By Doris Ryan, Bureau of Medicine and Surgery
WASHINGTON — By capitalizing on a pilot's innate sense
of touch. Navy medical researchers are solving the problem
of spatial disorientation. Their work can mean a major
breakthrough in aviation safety — the payoff is lives
In 1989 Capt. Angus H Rupert, MC, a Navy flight surgeon
first proposed a non-visual solution to provide intuitive
spatial orientation — the Tactile Situation Awareness
System (TSAS) . Using touch in concert with vision, pilots
would constantly know where down is.
The cause of spacial disorientation in flight is
biological according to Rupert, who is the principle
investigator on the project at the Naval Aerospace Medical
Research Laboratory in Pensacola, Fla.
"On the ground, in our day-to-day activities, spatial
orientation is continuously maintained by accurate
information from three independent, redundant, and
concordant sensory systems — vision, the vestibular system
(inner ear) , and the somatosensory system (skin, muscle,
joints) . We walk upright without giving a second thought
to the complex processes at play within our bodies.
The research team, which based its technology on biology
and basic human senses, designed a prototype computer and
lightweight flight vest that translates digital information
from the aircraft' s orientation instruments into
vibrations . The pilot feels the vibrations from tactile
stimulators sewn into a flight vest . Touch becomes a
continuous spatial orientation cue.
The flight vest lets the pilot know where the ground is
at all times. The pilot literally feels the orientation
with respect to the ground. For example, a vibration near
the right shoulder means the aircraft banked right at 90
degrees, a vibration lower under the arm indicates a 45-
degree right bank. A vibration at the navel indicates the
aircraft' s nose is down.
Rupert said, "TSAS has the capability of providing a
wide variety of flight parameter information, for exaiaple,
attitude, altitude, velocity, navigation, acceleration and
threat location. TSAS, integrated with visual and audio
display systems will provide the right information at the
right time by the right sensory channels and represents the
next generation human systems interface for tactical
aircraft . "
For more information about TSAS and other Naval
Aerospace Medical Research projects, visit the web site at
Headline: Great Lakes blood bank accredited
By Lt . Youssef H. Aboul—Enein, MSG, Naval Hospital Great
Great Lakes, 111. - Cmdr. Kenneth W. Sapp, MC, head of
the Clinical Laboratory Department, announced recently that
the blood bank and blood donor center of the naval hospital
has been accredited by the American Association of Blood
The association is a worldwide organization that is
dedicated to the highest standards of excellence in blood
collection and transfusion. Founded in 1947, the
association is a voluntary professional society of almost
9, 000 members and an institutional membership of more than
2, 000 community, regional and hospital based blood bank
"Accreditation is a major accomplishment that it
recognized around the world." said Lt . Cmdr. Stephan F.
Jun, MC, medical director of the blood bank and donor
center. It involves the successful completion of a
rigorous on-site inspection by an outside assessor who has
been specifically trained and by the association .
"It is quite an honor for our blood bank and donor
center." said Lt. Roland L. Fahie, MSG, director of the
Midwest Region of the Navy Blood Program. "The real credit
goes to our blood bank and donor center staff; Hospital
Corpsman 1st Class Jeff Diffy; Hospital Corpsmen 2nd Class
Robert Neumann and Lee Witter; Hospital Corpsmen 3rd Class
Sandia Valdez, Robert Evans, Bill Lewandowski, and others.
It was their outstanding efforts and personal dedication to
excellence that resulted in a successful inspection and
accreditation . "
Headline: Exceptional Family Member Program gets new
By Tom Marko, Bureau of Medicine and Surgery
WASHINGTON — Navy Surgeon General Vice Adm. Richard A.
Nelson signed a totally revised instruction addressing the
Suitability Screening and Exceptional Family Member
programs. BUMED Instruction 1300.2, 17 Feb 00, "Medical,
Dental, and Educational Suitability Screening and
Exceptional Family Member Program Enrollment " is now policy
and includes the following changes:
- Cancels NAVMEDCOMINST 1300. IC, 23 Mar 89.
- Provides comprehensive policy and procedures medical,
dental, and educational screening for overseas, remote duty
and operational assignments
- Provides comprehensive EFMP enrollment procedures.
- Replaces NAVMED Form 1300/1 (Rev. 8-99) (Test) with
NAVMED Form 1300/1 (Rev. 2-00) .
- Replaces SF 600 overprint with NAVMED Form 1300/2
(rev. 2-00) .
- Incorporates interim message guidance and women 's
health care policy issued since March 1989.
- Eliminates the pregnancy test requirement 30 days
prior to transfer .
- Requires screening after periods of temporary limited
duty and finding of "fit for continued Naval service" by a
Physical Evaluation Board.
- Addresses special screening requirements
- Adds guidance on early intervention, special education
and civilian employee screening.
BUMED Instruction 1300.2 is available for download at
http : //navymedicine. med.navy.mil/instructions/external/exte
If you have any questions concerning the instruction,
contact Tom Marko (MED-31BAS) at TLMarko@us.med.navy.mil;
DSN 762-3107 . For operational assignments, contact CAPT
Jay Montgomery at JRMontgomery@us.med.navy.mil. Phone DSN
Headline: Anthrax question and answer
From Bureau of Medicine and Surgery
Question: Why will it take the DoD and Coast Guard so
long to vaccinate the total force?
Answer: There is not enough vaccine to vaccinate
everyone at once. Therefore, the DoD has a phased—
implementation program, starting with personnel in high-
threat areas. Applying any program, procedures or process
to the entire U.S. military force is a complicated and
expensive process that must be thoroughly planned and
carefully executed to achieve the desired results.
Protection against anthrax is particularly challenging
because the vaccination protocol requires multiple doses to
achieve immunity, and thus involves significant
administrative and logistical issues.
For more information visit the Navy anthrax web site at
http: www-nehc . med . navy . mi 1/prevmed/immun/ anthrax .htm, or
the DOD anthrax web site at http://www.anthrax.osd.mil/.
Headline: TRICARE question and answer
From Bureau of Medicine and Surgery
Question: Does the copayment increase for the emergency
Answer: There are no out-of-pocket costs for any care
received at a military hospital, including emergency room
care. The out-of-pocket costs for care received at a
civilian emergency room for families of E—4 and below
enrolled in Prime is $10. For families of E-5 and above
and retirees and their families, the copay for an emergency
room visit is $30.
This single payment, $10 or $30, includes all emergency
room services provided in conjunction with the visit. For
those who have chosen to remain in TRICARE Standard, or use
the TRICARE Extra program, their regular deductibles and
For more information visit the TRICARE web site at
http: //www. tricare.osd.mil
Headline: Healthwatch: Oral cancer: are you at risk?
From Bureau of Medicine and Surgery
WASHINGTON — The most common form of oral cancer is
known as squamous cell carcinoma. It classically develops
as a crater-like lesion having a velvety red base with
rough edges similar to a very bad "pizza burn. " However,
it may appear as white patches, with some irregular red
patches, mixed together in its earlier stages.
An important aspect of squamous cell carcinoma is its
location within the mouth. The lower lip and the tongue
are the most frequent sites with the floor of the mouth not
Lesions are usually solitary but in some cases have been
found to occur in groups. The concern with the location is
that certain areas allow the cancer an easier route to
spread to other parts of the body, metastasize, and lessen
chances for a good prognosis . Lesions found on the back
third of the tongue have the greatest chance to
metastasize, usually to lymph nodes in the neck.
As with most cancers we still don 't know everything
there is to know about what causes squamous cell carcinoma,
but we do know what increases the risks of developing it.
The use of tobacco products (smoking, snuff, pipe,
cigar, etc.) is a major risk factor, but also the use of
alcohol products has been found to increase the risks of
developing the cancer.
When these two risk factors are put together, it becomes
the greatest risk factor. This is why the highest
occurrence of oral cancer is found in the middle— aged to
elderly male population who have a history of tobacco and
or alcohol use.
The treatment of squamous cell carcinoma depends on
several factors: time of detection, size of tumor, spread
of tumor, etc. Treatments may range from surgical removal
of the tumor, radiation of the tumor or chemotherapy. Most
occurances will require a combination of these treatments .
The overall 5-year survival rate for all oral cancer
patients is about 40%. This percentage is getting better
as we are detecting the cancer earlier and educating
patients to the risk factors associated with the cancer.
It is very important that patients periodically examine
their mouths for any changes that could be associated with
oral cancer. A self-exam is fairly simple and could save a
patient's life. It must be understood that there is very
little, if any, pain associated with oral cancer until the
very late stages. Therefore, it is imperative that people
routinely stand in front of the mirror and actually take a
look inside of their mouth.
Use a mirror with good lighting, open your mouth wide
enough to see all of your teeth and the back of your
throat . A good time to do this is right after you brush
your teeth. Look at the insides of your cheeks, the roof
of your mouth, your tongue (especially the sides as far
back as possible) , the floor of your mouth, your gums and
the inside of both of your lips.
Note anything that appears to be an odd color, texture,
or shape especially when it is only found on one side of
your mouth . Keep in mind that early signs of squamous cell
carcinoma usually show up as white or red patches or some
Should you find anything suspicious, schedule an
appointment with your dentist for a professional exam,
especially if you fall into one of the high risk groups
(use of tobacco and or alcohol) . Your dentist should
examine an ulcer in your mouth that doesn't heal within two
weeks. Dentists routinely do an oral cancer screening upon
your normal check-ups , but do not neglect to do a self-exam
on your own mouth at least once a week.
Remember, the earlier that squamous cell carcinoma is
detected, the better the prognosis . As with all oral
health concerns, prevention is the key to success.
Comments about and ideas for MEDNEWS are welcome. Story
submissions are encouraged. Contact MEDNEWS editor. Earl
W. Hicks, at email: firstname.lastname@example.org; Telephone
202/762-3223, (DSN) 762-3223, or fax 202/762-3224.